Essential public healthcare services utilisation and excess non-COVID-19 mortality in Greece

 E. Kondilis* , F. Tarantilis, A. Benos School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece


Objectives:Ensuring access to care for all patientsdespecially those with life-threatening and chronicconditionsdduring a pandemic is a challenge for all healthcare systems. During the COVID-19 pandemic,many countries faced excess mortality partly attributed to disruptions in essential healthcare servicesprovision. This study aims to estimate the utilization of public primary care and hospital services duringthe COVID-19 epidemic in Greece and its potential association with excess non-COVID-19 mortality in thecountry.

Study design:This is an observational study.

Methods:A retrospective analysis of national secondary utilization and mortality data from multipleofficial sources, covering thefirst nine months of the COVID-19 epidemic in Greece (February 26thtoNovember 30th, 2020), was carried out.

Results:Utilization rates of all public healthcare services during thefirst nine months of the epidemicdropped significantly compared to the average utilization rates of the 2017e19 control period; hospitaladmissions, hospital surgical procedures, and primary care visits dropped by 17.3% (95% CI: 6.6%e28.0%),23.1% (95% CI: 7.3%e38.9%), and 24.8% (95% CI: 13.3%e36.3%) respectively. This underutilization ofessential public servicesdmainly due to supply restrictions such as suspension of outpatient care andcancelation of elective surgeriesdis most probably related to the 3778 excess non-COVID-19 deaths(representing 62% of all-cause excess deaths) that have been reported during thefirst 9 months of theepidemic in the country.

Conclusions:Greece's healthcare system, deeply wounded by the 2008e18 recession and austerity, wasill-resourced to cope with the challenges of the COVID-19 epidemic. Early and prolonged lockdowns havekept COVID-19 infections and deaths at relatively low levels. However, this“success”seems to have been accomplished at the expense of non-COVID-19 patients. It is important to acknowledge the“hiddenepidemic”of unmet non-COVID-19 needs and increased non-COVID-19 deaths in the country and ur-gently strengthen public healthcare services to address it.

©2021 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.


E. Kondilis, F. Tarantilis, A. Benos,
Essential public healthcare services utilization and excess non-COVID-19 mortality in Greece,
Public Health,
Volume 198,
Pages 85-88,


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